Clinical Quality Management Coordinator
Arizona State Government, Phoenix, AZ, United States
Clinical Quality Management Coordinator
Office of the Director (OOD)
Job Location:
150 North 18th Avenue Phoenix, Arizona 85007
All AHCCCS employees must reside within the state of Arizona.
Salary:
Starting at $71,032, may increase based on experience and qualifications.
Grade:
22
FLSA Status:
Exempt
This position will remain open until filled.
Job Summary:
This position will work independently applying clinical knowledge, judgment, and expertise to assess, coordinate, and monitor service delivery. It will complete comprehensive assessments of available resources on service providers and individual members; review case material to ensure compliance with State and Federal regulations and policies; and provide timely resolution of multiple cases assigned. It will also be responsible for identifying systemic issues for AHCCCS to address. The role is hybrid with some in‑office meetings, on‑site investigations, and reviews as needed. Occasionally, the position may also participate as needed in urgent on‑site investigations and reviews outside of normal business hours and weekends.
Major Duties and Responsibilities:
Monitor compliance with State and Federal regulations pertaining to quality management processes, tracking, and trending quality of care concerns and/or health and safety/immediate jeopardy concerns. Receive, research, document, and resolve quality of care and/or health and safety issues utilizing standardized processes. Track, trend, and monitor the status of cases to ensure accurate and timely completion and appropriate referrals using a centralized case tracking management database. Ensure research and resolution of issues or concerns promptly as assigned and identify systemic issues for AHCCCS to address.
Contribute clinical knowledge to assist in the resolution of quality of care concerns, clinical reviews, and operational reviews. Complete an independent review of data management and other deliverables, technical assistance, and focused studies/reviews, including the behavioral health delivery system, to ensure compliance with contractual and policy requirements for all lines of business. Follow up on written reports, action plans, provider education, and related actions as appropriate.
Ensure quality of care to AHCCCS members, including ensuring member dignity and respect, focused on their unique special health care needs, timely correspondence, and resolution of the quality of care concern. Use independent judgment regarding data to research, status level, interventions, and appropriate resolution.
Provide education and technical assistance to internal and external stakeholders, as appropriate, regarding covered services, and contractual or policy requirements, accurately and consistently to improve compliance with AHCCCS requirements and improve quality of care and service to AHCCCS members.
Develop improved processes and procedures to improve the efficiency of the unit. Lead special projects and reviews to ensure completion within the designated timelines. Provide ongoing updates to Management.
Develop metrics for population‑specific outcome objectives. Track, evaluate, analyze, and revise metrics as needed based on the ongoing analysis of member data.
Conduct on‑site investigations regarding possible health and safety concerns, immediate jeopardy situations, and other situations supporting AHCCCS initiatives and ventures. On‑site visits may also occur outside of normal business hours and weekends for immediate and urgent situations.
Knowledge, Skills & Abilities (KSAs):
Knowledge of:
State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, and LTC Supports and Services
Current standards of medical/behavioral practice and modes of delivery for acute and non‑acute medical/behavioral care/services
Data management and utilization review regulations, rules and processes
AHCCCS and Medicaid regulations, policies, and procedures and applicable federal and state statutes, regulations and rules
Medical
ursing practice, medical case management protocols, utilization review protocols as related to the acute, LTC, chronic long‑term elderly and physically disabled, developmentally disabled, and behavioral/mental health
Case management development, implementation, and ongoing review
Skilled in:
Acute nursing and clinical processes including assessment, planning, intervention, and evaluation
Clinical assessment skill
Techniques to select a particular approach to analyze, develop, or implement a policy, project management methodologies, and Behavioral Health delivery system
Problem‑solving techniques, evaluation, and initiation of appropriate action
Excellent communication, verbal and written
Organizational skills for setting priorities, workload, and record‑keeping
Strong interpersonal skills in working with agency management, and people of diverse cultures and socioeconomic backgrounds
Project management to meet goals and deadlines
Research and analytical skills
Documentation and reporting of data and trends
Ability to:
Collaborate with others for a mutually beneficial outcome
Interpret clinical information and assess implications for treatment
Read, interpret and apply complex rules and regulations
Independent decision making, yet knowing when to elevate an issue or concern
Assess variables which impact health and functioning
Make effective decisions in a high volume, fast paced environment
Write comprehensive reports
Qualifications:
May require a valid Arizona driver’s license for travel‑related duties.
Minimum:
Must maintain a current Arizona medical license (RN or higher) and 3 years of relevant healthcare experience.
Preferred:
At least one year experience working in a managed care environment. Case Management, Quality Management, Utilization Management and/or social work experience. Certified Professional in Healthcare Quality or case management certification. NOTE: If position is required to drive on state business, the position will require the possession of and abilit
Pre‑Employment Requirements:
Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above‑mentioned process and the agency’s ability to reasonably accommodate any restrictions.
Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12).
Driver’s License Requirements apply if the position requires driving or vehicle use as an essential function.
All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E‑Verify).
Benefits:
10 paid holidays per year
Paid Vacation and Sick time off (13 and 12 days per year respectively) – start earning it your 1st day (prorated for part‑time employees)
Paid Parental Leave – up to 12 weeks per year paid leave for newborn or newly‑placed foster/adopted child. Learn more about the Paid Parental Leave pilot program here
Other Leaves – Bereavement, civic duty, and military
A top‑ranked retirement program with lifetime pension benefits
A robust and affordable insurance plan, including medical, dental, life, and disability insurance
Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
RideShare and Public Transit Subsidy
A variety of learning and career development opportunities
Retirement:
Lifetime Pension Benefit Program: Administered through the Arizona State Retirement System (ASRS); defined benefit plan that provides for lifetime income upon retirement; required participation for Long‑Term Disability (LTD) and ASRS Retirement plan; pre‑taxed payroll contributions begin after a 27‑week waiting period (prior contributions may waive the waiting period).
Deferred Retirement Compensation Program: Voluntary participation; program administered through Nationwide; tax‑deferred retirement investments through payroll deductions.
Contact Us:
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation.
The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.
#J-18808-Ljbffr
Office of the Director (OOD)
Job Location:
150 North 18th Avenue Phoenix, Arizona 85007
All AHCCCS employees must reside within the state of Arizona.
Salary:
Starting at $71,032, may increase based on experience and qualifications.
Grade:
22
FLSA Status:
Exempt
This position will remain open until filled.
Job Summary:
This position will work independently applying clinical knowledge, judgment, and expertise to assess, coordinate, and monitor service delivery. It will complete comprehensive assessments of available resources on service providers and individual members; review case material to ensure compliance with State and Federal regulations and policies; and provide timely resolution of multiple cases assigned. It will also be responsible for identifying systemic issues for AHCCCS to address. The role is hybrid with some in‑office meetings, on‑site investigations, and reviews as needed. Occasionally, the position may also participate as needed in urgent on‑site investigations and reviews outside of normal business hours and weekends.
Major Duties and Responsibilities:
Monitor compliance with State and Federal regulations pertaining to quality management processes, tracking, and trending quality of care concerns and/or health and safety/immediate jeopardy concerns. Receive, research, document, and resolve quality of care and/or health and safety issues utilizing standardized processes. Track, trend, and monitor the status of cases to ensure accurate and timely completion and appropriate referrals using a centralized case tracking management database. Ensure research and resolution of issues or concerns promptly as assigned and identify systemic issues for AHCCCS to address.
Contribute clinical knowledge to assist in the resolution of quality of care concerns, clinical reviews, and operational reviews. Complete an independent review of data management and other deliverables, technical assistance, and focused studies/reviews, including the behavioral health delivery system, to ensure compliance with contractual and policy requirements for all lines of business. Follow up on written reports, action plans, provider education, and related actions as appropriate.
Ensure quality of care to AHCCCS members, including ensuring member dignity and respect, focused on their unique special health care needs, timely correspondence, and resolution of the quality of care concern. Use independent judgment regarding data to research, status level, interventions, and appropriate resolution.
Provide education and technical assistance to internal and external stakeholders, as appropriate, regarding covered services, and contractual or policy requirements, accurately and consistently to improve compliance with AHCCCS requirements and improve quality of care and service to AHCCCS members.
Develop improved processes and procedures to improve the efficiency of the unit. Lead special projects and reviews to ensure completion within the designated timelines. Provide ongoing updates to Management.
Develop metrics for population‑specific outcome objectives. Track, evaluate, analyze, and revise metrics as needed based on the ongoing analysis of member data.
Conduct on‑site investigations regarding possible health and safety concerns, immediate jeopardy situations, and other situations supporting AHCCCS initiatives and ventures. On‑site visits may also occur outside of normal business hours and weekends for immediate and urgent situations.
Knowledge, Skills & Abilities (KSAs):
Knowledge of:
State and Federal Policies and Procedures governing Title XIX, Title XXI, Managed Care, and LTC Supports and Services
Current standards of medical/behavioral practice and modes of delivery for acute and non‑acute medical/behavioral care/services
Data management and utilization review regulations, rules and processes
AHCCCS and Medicaid regulations, policies, and procedures and applicable federal and state statutes, regulations and rules
Medical
ursing practice, medical case management protocols, utilization review protocols as related to the acute, LTC, chronic long‑term elderly and physically disabled, developmentally disabled, and behavioral/mental health
Case management development, implementation, and ongoing review
Skilled in:
Acute nursing and clinical processes including assessment, planning, intervention, and evaluation
Clinical assessment skill
Techniques to select a particular approach to analyze, develop, or implement a policy, project management methodologies, and Behavioral Health delivery system
Problem‑solving techniques, evaluation, and initiation of appropriate action
Excellent communication, verbal and written
Organizational skills for setting priorities, workload, and record‑keeping
Strong interpersonal skills in working with agency management, and people of diverse cultures and socioeconomic backgrounds
Project management to meet goals and deadlines
Research and analytical skills
Documentation and reporting of data and trends
Ability to:
Collaborate with others for a mutually beneficial outcome
Interpret clinical information and assess implications for treatment
Read, interpret and apply complex rules and regulations
Independent decision making, yet knowing when to elevate an issue or concern
Assess variables which impact health and functioning
Make effective decisions in a high volume, fast paced environment
Write comprehensive reports
Qualifications:
May require a valid Arizona driver’s license for travel‑related duties.
Minimum:
Must maintain a current Arizona medical license (RN or higher) and 3 years of relevant healthcare experience.
Preferred:
At least one year experience working in a managed care environment. Case Management, Quality Management, Utilization Management and/or social work experience. Certified Professional in Healthcare Quality or case management certification. NOTE: If position is required to drive on state business, the position will require the possession of and abilit
Pre‑Employment Requirements:
Successfully pass fingerprint background check, prior employment verifications and reference checks; employment is contingent upon completion of the above‑mentioned process and the agency’s ability to reasonably accommodate any restrictions.
Travel may be required for State business. Employees who drive on state business must complete any required driver training (see Arizona Administrative Code R2-10-207.12).
Driver’s License Requirements apply if the position requires driving or vehicle use as an essential function.
All newly hired State employees are subject to and must successfully complete the Electronic Employment Eligibility Verification Program (E‑Verify).
Benefits:
10 paid holidays per year
Paid Vacation and Sick time off (13 and 12 days per year respectively) – start earning it your 1st day (prorated for part‑time employees)
Paid Parental Leave – up to 12 weeks per year paid leave for newborn or newly‑placed foster/adopted child. Learn more about the Paid Parental Leave pilot program here
Other Leaves – Bereavement, civic duty, and military
A top‑ranked retirement program with lifetime pension benefits
A robust and affordable insurance plan, including medical, dental, life, and disability insurance
Participation eligibility in the Public Service Loan Forgiveness Program (must meet qualifications)
RideShare and Public Transit Subsidy
A variety of learning and career development opportunities
Retirement:
Lifetime Pension Benefit Program: Administered through the Arizona State Retirement System (ASRS); defined benefit plan that provides for lifetime income upon retirement; required participation for Long‑Term Disability (LTD) and ASRS Retirement plan; pre‑taxed payroll contributions begin after a 27‑week waiting period (prior contributions may waive the waiting period).
Deferred Retirement Compensation Program: Voluntary participation; program administered through Nationwide; tax‑deferred retirement investments through payroll deductions.
Contact Us:
Persons with a disability may request a reasonable accommodation such as a sign language interpreter or an alternative format by emailing careers@azahcccs.gov.
Requests should be made as early as possible to allow time to arrange the accommodation.
The State of Arizona is an Equal Opportunity/Reasonable Accommodation Employer.
#J-18808-Ljbffr